Claim Form Rule: Adding PCS Codes

  • Updated

What claim change is needed?

To add the PCS code to the UB-04 form.  PCS codes are the procedural classification codes, different from the ICD-10 codes, used in inpatient and hospital settings.

Box Number

UB-04: Box 74 - Principal Procedure Code and Date

Steps

  1. Navigate to Management Center > Claim Rules
  2. Click "Create Claim Form Rule".
  3. Select the Practice.
    mceclip2.png
  4. Name the claim rule.
    Screen_Shot_2021-05-23_at_2.10.31_PM.png
  5. Set Claim Type to Institutional depending upon service.
    mceclip1.png  
  6. Set conditions for the claim rule to be met.
  7. Select the Available Behavior:  PCD Codes.
    Screen_Shot_2021-05-23_at_1.58.17_PM.png
  8. Then click Add.
  9. Input the PCS code(s) related to the scenario in question.
    Screen_Shot_2021-05-23_at_2.15.18_PM.png
  10. At the bottom of the window, click the Create button.

Related Articles

Box 74a-e - Other Procedure Information

To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.

To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.

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